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A program in Washington State was initiated in 1987 in an effort to provide support for homeless pregnant and parenting teens. The approach was intensive team case management and eligibility criteria were: under the age of 18 years and pregnant a history of prostitution or survival sex in street activity and estranged from home and family or adult supervision. The aim of the Out-Of-Home Teenage Pregnancy Project was to establish prenatal and primary health care build a supportive network of services stabilize the living situation and provide intensive case management. The team included a public health nurse and a social worker. Services were provided in the field and included facilities throughout the county rather than being bounded by district lines. Services involved outreach education crisis intervention counseling drug treatment and mental health referral assistance in obtaining medical care and social services assistance with financial and housing arrangements medical assessment of the mother and child intervention and referral to other community services. Because this population was difficult to serve alternative interventions were developed: provision of transportation walking through the bureaucratic process with the client and provision of healthy role modeling. The project has provided documentation of attitudes outcomes postpartum follow-up and other information on this vulnerable maternal and infant population. During the 7 years of operation about 200 adolescents have been served and the current caseload is about 30-35 clients. The annual budget was $106745 or $3050 per client per year. Funding has come from the Washington State Department of Health Division of Parent and Child Health Services and the Seattle-King County Health Department. Other funding has included First Steps case management reimbursement and AIDS prevention education funds. The approach has stressed the development of trusting relationships that contribute to healthful change and risk reduction. There must be consistent support long-term interaction and follow-up.